Objective To evaluate surgical treatment of severe liver injury.Methods Retrospective analysis on 52 patients with severe liver injury from October 2002 to April 2015 was made in accordance with liver damage by the American Institute of Traumatic Surgery (AAST),incorporated with imaging examinations and intraoperative findings.There were 19 cases of grade Ⅲ,27 of grade Ⅳ,6 cases of grade V.All patients were treated by surgery:simple suture in 4 cases,omentum tamponade in 16 cases,debridement hepatectomy was performed on 24 cases,hepatic segment resection in 2 cases,right liver resection in 1 case,peripheral hepatic gauze packing in 5 cases.Results 48 cases were cured,4 cases died.The cure rate was 92.3％ (48/52),mortality was 7.7％ (4/52),with one dying of right portal vein rupture and bleeding,3 of multiple organ failure.28 patients had one or more complications including postoperative hemorrhage in 3 cases,bile leakage in 6 cases,liver abscess in 5 cases,pleural effusion in 6,incision infection in 3 cases,and deep vein thrombosis of lower limbs in 2.Conclusions CT examination can identify type and degree of liver injury.Level Ⅰ-Ⅱ liver injury are recommended to nonoperative treatment,while level Ⅲ-V liver injury especially with hemodynamic instability or combined with other internal organs injury should be managed surgically.

Pemetrexed is a multitargeted anti-metabolite.Pemetrexed has been approved as first-line treatment in malignant pleural mesothelioma(MPM)and second-line treatment in non-small cell lung cancer(NSCLC).A lot of experimental and clinical trials on pemetrexed have been conducted for the treatment of several kinds of cancer now.This paper summarizes the current developments in experimental and clinical research.

Objective: To analyze the relationship between Stat 3 protein expression and clinical staging, tissue types, P53 protein and PCNA in lung carcinoma, and to investigate the role of Stat 3 protein in the pathogenesis of lung carcinoma. Methods: Using immunohistochemical technique, Stat 3 protein, P53 protein and PCNA were detected in different tissue in 42 patients with lung carcinoma without radiotherapy and chemotherapy. Results: The positive rate of Stat 3 was 81.0% in lung carcinoma. The expression intensity of Stat 3 in lung carcinoma was not associated with T,N and clinical stage , but it was associated with the expression intensity of P53 and PCNA and it was related to tissue types.Stat 3 protein were markedly higher in NSCLC than that in SCLC. Conclusion: The expression of Stat 3 protein is abnormal in lung carcinoma. Stat 3 may involve in regulation of p53 gene in lung carcinoma cell and accelerate proliferation of lung carcinoma cell, it may play an important role in generation of lung carcinoma. Inhibition of Stat 3 pathways may become a new therapy for lung carcinoma.

Objective To determine the expression of E-cadherin-catenins complex(E-cad,?-cat,?-cat and ?-cat) in early gastric cancer and their relationships with biological characteristics of early gastric cancer by evaluating the invasion and the lymph nodes metastasis of eraly gastric cancer(ECG).Methods 53 cases of EGC,who accepted radical operations from January 1997 to December 2000 in Sir Run Show Hospital were included in this study.According to the invasion depth and lymph nodes metastasis,they were divided into different sub-groups for discussion.Also the normal gastric mucosa of 10 cases with extra-gastric disease were selected as control group.Results All four proteins(E-cad,?-cat,?-cat and ?-cat) were normally expressed in control group.In early gastric cancer,the abnormal expression rates of E-cad,?-cat,?-cat and ?-cat were 64.2%,69.8%,66% and 73.6%,respectively.In the sub-group of mucosal invasion,the abnormal expression rates were 61%(14/23),65.2%(15/23),47.8%(11/23) and 56.5%(13/23),respectively.But in the sub-group of submucosal invasion,the abnormal expression rates were 66.7%(20/30),73.3(22/30)%,80%(24/30) and 86.7%(26/30),respectively.In sub-group of no lymph node metastasis,the abnormal expression rates were 61.4%(27/44),65.9%(29/44),63.6%(28/44) and 70%(31/44) respectively.In sub-group of lymph node metastasis,the abnormal expression rates were 77.8%(7/9),88.9%(8/9),77.8%(7/9) and 88.9%(8/9) respectively.Abnormal expression of ?-cat and ?-cat had significantly difference between the sub-group of mucosal invasion and the submucosal invasion(P

Objective To evaluate the management strategy for gallbladder carcinoma found during the procedure of intended laparoscopic cholecystectomy (LC) Methods Twenty one cases of primary gallbladder carcinoma were incidently found during a period of 1996-2003, among them 17 cases of Nevin stage Ⅱ、Ⅲ and Ⅳ were divided into group A (6 cases) converted to open radical resection, and group B (11 cases) treated by LC ? 2 test and Kaplan Meier analysis were used to analyze postoperative survival rates Results (1) Two Nevin stage Ⅰ cases are still alive for 6 and 47 months at a follow up after LC; (2) For stage Ⅱ、 Ⅲ and Ⅳ patients, open surgery resulted a much longer survival ( ? 2=4 55, P =0 0328) Conclusion (1) For Nevin stage Ⅰ patients, simple LC is enough; (2) Patients of Nevin stage Ⅱ、 Ⅲ and Ⅳ should be coverted to open radical resection

Objective To explore the clinical characteristics of critically ill children infected with pseudomonas aeruginosa(PA) and PA antibiotics resistance in pediatric intensive care unit (PICU).Methods Case records of children with PA infection admitted to PICU in children′s hospital affiliated to Shanghai Jiaotong University from Jan 2007 to Dec 2009 were reviewed for clinical characteristics,case fatality rate,prognosis and drug resistance.Results (1) Clinical features:12 cases were community-acquired infection and 46 cases were hospital-acquired infections in 58 cases.On the same period,hospital-wide surveillance obtained PA 232 strains,PICU obtained PA 112,the ratio was 48.3%.Twelve cases died and total mortality was 20.7%.The mortality was significantly difference between community-acquired infections (5 cases,41.6%)and hospital-acquired infections (7 cases,15.2%)(P<0.05).The main symptom of children with community-acquired infections were intestinal infection (5 cases) and sepsis (5 cases).The children had acute onset and developed to shock and multiple organ dysfunction syndrome rapidly.Laboratory examination revealed the white blood cell normal (7/12) and decreased in 5 cases (5/12).The value of C-reactive protein was increased significantly,and the concentration of blood endotoxin were also increased.In the hospital-acquired PA infection cases,the main symptom was respiratory abnormal (38 cases),worsen primary disease,extended staying days in PICU.(2)Drug resistance analysis:112 PA,69.8% of ceftazidime-resistant,72.8% of the imipenem-resistant.Conclusion There is significant difference of the clinical features between PA community-acquired infection and hospital-acquired infection.The former is mostly primary infections with high fatality rate.PA hospital-acquired infection has become an important pathogen of nosocomial infection in PICU.And it is important to prevent PA infection caused by a long term broad-spectrum antibiotics application and invasive medical procedures.

Objective To compare the sensitivity and specificity of mucin 7(Muc7) mRNA test with urine cytology in detection bladder cancer.Methods In 86 patients suspected with bladder cancer,RT-PCR for Muc7 mRNA and urine cytology were conducted in the same urine samples.Fif-ty-two patients with bladder transitional cell carcinoma were confirmed histologically.The sensitivity and specificity of Muc7 mRNA and urine cytology were analyzed.Results The overall sensitivity,specificity and false positive of Mue7 mRNA test were 84.6%,85.2% and 14.7% respectively.Those of urine cytology were 34.6%,91.2% and 8.8% respectively.There were no significant differences between urine cytology and Muc7 mRNA test in the specificity and false positive; however,Muc7 mRNA had significantly higher sensitivity than urine cytology in detection of bladder cancer.Conclusion The sensitivity of Muc7 mRNA test is superior to urine cytology in detection of bladder cancer.

Objective To compare the efficacy of different volume of ropivacaine and lidocaine for ultrasound-guided infraclavicular brachial block.Methods Sixty patients scheduled for distal upper limb surgery were divided into group A and group B by random digits table method with 30 cases each.The patients were given ultrasound-guided infraclavicular brachial block,but the patients in group A using 0.3％ ropivacaine mixed with 1％ lidocaine 20 ml,the patients in group B using the same mixture 30 ml.Sensory block was assessed every 5 min after the block.Motor block was evaluated at 30 min after the block.The onset time of anesthesia,surgical success rate,complications and duration of anesthesia were recorded.Results There was no significant difference in the surgical success rate [93.3％(28/30) vs.96.7％(29/30),P＞0.05],onset time of sensory block [10 (5) min vs.5 (5) min,P＞0.05] and degree of motor block between the 2 groups.The duration of anesthesia in group A was shorter than that in group B (P ＜ 0.05).Conclusion The efficacy of ultrasound-guided infraclavicular brachial block with the mixture of 0.3％ ropivacaine and 1％ lidocaine 20 ml and 30 ml is similar in surgical success rate and onset time of anesthesia.

OBJECTIVE To analyze the bacterial distribution and drug resistance in lower respiratory tract nosocomial infection(NI).METHODS To investigate 351 patients suffered from lower respiratory tract NI using the prospective monitoring methods,and doing the pathogenic bacterium cultivation for sputums of 351 patients and then taking the susceptibility test.RESULTS Totally 346 pathogenic bacteria were found in sputums of 351 patients.The major pathogenic bacteria were Pseudomonas aeruginosa,Escherichia coli,Klebsiella and Staphylococcus aureus.ESBLs were 36.0% and 40.0%,respectively in E.coli and Klebsiella,and MRSA were 82.1% in S.aureus.Drug resistances were common in Gram-negative bacilli(GNB) and Gram-positive cocci.Piperacillin/tazobactam and cefoperazone/sulbactam and imipenem were the most sensitive for GNB,S.aureus,S.epidermidis and Enterococcus were all sensitive to vancomycin.CONCLUSIONS Drug resistance of the pathogenic bacteria in lower respiratory tract NI is common,so it′s necessary to emphasize pathogenic bacterium monitoring and use the antibacterials exactly.

OBJECTIVE By investigating the incidence of nosocomial infection with objective monitoring method and prospective overall monitoring method, to analyze the advantage and significance between two methods. METHODS Using the objective monitoring method to study the incidence of nosocomial infection of patients after neurosurgical operation from May to December in 2003 and using the prospective overall monitoring method to study the incidence of nosocomial infection of patients after neurosurgical operation from May to December in 2002. All data were analyzed with Stata 7.0 soft. RESULTS There were 100 cases occurring nosocomial infection in 267 neurosurgical operation patients. The patient incidence of nosocomial infection was 37.5% and the rate of nosocomial infection cases was 50.9% with objective monitoring method, that was significant higher than those data coming from May to December in 2002 with 248 cases under prospective overall monitoring method, with which the patient incidence of nosocomial infection and the rate of nosocomial infection cases were 20.2%(50 cases ) and 21.4%(53 cases), respectively . Statistically significant difference was found (P